Men who have sex with men (MSM) presenting for integrated crystal methamphetamine treatment and HIV risk reduction: results from project IMPACT screening

Published: July 21, 2010

S.L. Reisner1,2, M.J. Mimiaga1,2,3, S. Bland1, B. Perkovich1,4, D.W. Pantalone1,5, C. O’Cleirigh1,3, K.H. Mayer1,6, S.A. Safren1,3

1Fenway Health, The Fenway Institute, Boston, United States, 2Harvard School of Public Health, Boston, United States, 3Harvard Medical School / Massachusetts General Hospital, Boston, United States, 4Harvard College, Cambridge, United States, 5Suffolk University, Boston, United States, 6Brown Medical School/Miriam Hospital, Providence, United States

Background: Crystal methamphetamine (“meth”) abuse remains a treatment refractory problem, and has been associated with HIV risk behavior among men who have sex with men (MSM). Little research has examined characteristics of MSM who seek outpatient meth substance abuse treatment services.
Methods: Project IMPACT is a 10-session intervention combining behavioral activation therapy with HIV risk reduction counseling to decrease meth abuse and sexual risk-taking behaviors among HIV-uninfected MSM. A total of 76 men were screened for this intervention between June 2008 and November 2009, of which 42% were eligible and enrolled.
Results: MSM who screened for this intervention had a mean age of 39.6 (SD=10.0, 18-55) and 23% were unemployed. Fifty-six percent reported unprotected anal sex while using meth in the past 3 months. Substances used during recent sex included: 33% heavy alcohol, 31% cocaine, 28% marijuana, 26% poppers, 21% GHB, 20% erectile dysfunction medications, 18% crack, 15% heroin, 9% ecstasy. Mode of meth use included: 82% smoke, 43% injection (“slam”), 36% snort, 14% rectal (“booty bump”). The men reported significant mental health histories, including: 41% depression, 30% antidepressant medications, 31% past drug treatment, 25% psychiatric hospitalization. Overall, 18% were HIV-positive or did not know their HIV status. Most common reasons for ineligibility included: no meth use for >3 months, heroin use in the past 3 months, or being HIV-infected.
Conclusions: MSM who screen for meth treatment as part of an intervention study represent a group at high risk for HIV acquisition and transmission with many co-occurring problems, including mental health comorbidities and polysubstance abuse. Treatment interventions are needed to address these complex factors among MSM with meth abuse/dependence.

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